Purpose
Clinical observation has led to the discovery of a distinct anatomic septum from the
extensor tendon to the skin at the distal phalanx that appears to limit the proximal
spread of infection from the dorsum of the distal phalanx. This study employed histology
and high-resolution magnetic resonance imaging (MRI) to identify this anatomic structure
at the level of the distal interphalangeal (DIP) joint.
Methods
We used high-resolution (16.4-T) MRI to image and section 10 cadaveric fingers (9
female, 1 male) from both left and right hands. Once imaged, we made histologic sections
using hematoxylin and eosin, or Van Gieson's stain, and examined them microscopically
for concordant findings.
Results
In all 10 scans, the proposed septum was visualized using MRI with histologic confirmation.
It was observed to extend from the skin creases overlying the dorsal aspect of the
DIP joint to the extensor tendon. It is composed of collagen bundles arranged in a
variable network that adhere extensor tendon to skin at the DIP joint.
Conclusions
Clinical observations proposed the existence of a distinct septum between extensor
tendon and skin at the level of the DIP joint. We confirmed this structure to be a
collagen septum by MRI and histology. This previously undescribed structure is called
the dorsal septum.
Key words
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References
- The classic.Clin Orthop Relate Res. 1974; 104: 3-8
- The fascia of the distal phalanx.J Bone Joint Surg. 1975; 57A: 784-788
- Cutaneous ligaments of the phalanges.J Anat Physiol. 1878; 12: 106-107
- The retaining ligaments of the digits of the hand.in: Tubiana R. Hand. WB Saunders, Philadelphia1981: 232-235
- Paratendinous apparatus of the digital extensor mechanism: some clinical features.Henry Ford Hosp Med Bull. 1962; 10: 253-256
- The paratendinous apparatus of the digits.J Bone Joint Surg. 1962; 44B: 910-912
- The perionychium.in: Green D.P. Pederson W.C. Hotchkiss R.N. Wolfe S.W. Green's operative hand surgery. 5th ed. Elsevier/Churchill Livingstone, Philadelphia2005
- The dorsal plate of the proximal interphalangeal joint.J Hand Surg. 1990; 15B: 68-73
Article info
Publication history
Accepted:
November 25,
2008
Received:
October 2,
2008
Footnotes
Funding was provided by the School of Medicine at the University of Queensland.
Identification
Copyright
© 2009 Published by Elsevier Inc.
